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Session 6 Flashcards

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1
Q

The spleen consists of which two areas?

A

Red pulp

White pulp

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2
Q

What does the red pulp of the spleen consist of?

A

Sinuses lined by endothelial macrophages and cords

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3
Q

The white pulp of the spleen has a similar structure to…

A

Lymphoid follicles

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4
Q

Blood enters the spleen via which vessel?

A

Splenic artery

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5
Q

What preferentially passes through the white pulp of the spleen?

A

White cells

Plasma

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6
Q

What preferentially passes through the red pulp of the spleen?

A

Red cells

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7
Q

Name 4 functions of the spleen in adults

A

Removal of old/abnormal red cells through phagocytosis by macrophages

Blood pooling

Extramedullary haemopoiesis

Immunological function

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8
Q

Describe the extramedullary haemopoietic function of the spleen

A

In times of haematological stress/bone marrow failure pluripotent stem cells proliferate in the spleen

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9
Q

What cells (as well as macrophages) are present in the spleen that allows it to carry out its immunological function?

A

T cells

B cells

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10
Q

What is splenomegaly?

A

Enlargement of the spleen

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11
Q

It is not normal to palpate the spleen below…

A

The costal margin

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12
Q

What side of the body is the spleen normally on?

A

Left

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13
Q

Where do you begin palpating the spleen in suspected splenomegaly?

A

Right iliac fossa

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14
Q

As you begin palpating the spleen when will you feel the spleen edge move towards your hand?

A

On inspiration

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15
Q

What is the costal margin?

A

The lower edge of the chest formed by the bottom edge of the rib cage

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16
Q

In splenomegaly how is enlargement of the spleen measured?

A

In cm from the costal margin in the mid clavicular line

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17
Q

Give 3 possible causes of splenomegaly

A

Back pressure
Overworking red/white pulp
Extramedullary haemopoiesis
Infiltration by other cells/material

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18
Q

Give an example of cells that can infiltrate the spleen causing splenomegaly

A

Cancer cells - e.g. Leukaemia

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19
Q

Name a disease that can result in infiltration of the spleen by other material (not cells) resulting in splenomegaly

A

Gaucher’s disease

Sarcoidosis

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20
Q

Splenomegaly can be categorised into which types?

A

Massive
Moderate
Mild

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21
Q

Give 3 possible causes of massive splenomegaly

A

Chronic myeloid leukaemia
Myelofibrosis
Chronic malaria

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22
Q

As well as chronic malaria, myelofibrosis and chronic myeloid leukaemia, what are some causes of moderate splenomegaly?

A

Lymphoproliferative disorders

Myeloproliferative disorders

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23
Q

As well as the causes of massive/moderate splenomegaly, what can cause mild splenomegaly?

A

Infections

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24
Q

Give 2 examples of infections that can potentially cause splenomegally

A

Hepatitis

Endocarditis

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25
What is hypersplenism?
Overactive spleen
26
Why may thrombocytopenia and pancytopenia be seen in hypersplenism?
There is increased pooling of blood in the enlarged spleen
27
What risk is there if the spleen is enlarged?
Risk of rupture
28
Why is there risk of rupture of the spleen in splenomegaly?
It is no longer protected by the ribcage
29
A complication of splenomegaly is rupture of the spleen. What can result from this?
Haematoma (swelling of clotted blood in a tissue) and infarction
30
What is a haematoma?
A swelling of clotted blood in tissue
31
Describe the blood pooling function of the spleen
Pools blood so that platelets/red cells can be rapidly mobilised during bleeding
32
What is hyposplenism?
Lack of functioning splenic tissue
33
Name three causes of hyposplenism
Splenectomy Sickle cell disease Coeliac disease
34
How does sickle cell disease cause hyposplenism?
Through several infarcts and then fibrosis in the spleen
35
How will a blood film of someone with hyposplenism appear?
With Howell Jolly bodies
36
What are Howell Jolly bodies?
RBCs with DNA remnants in them
37
Patients with hyposplenism are at particular risk of..
Overwhelming sepsis from encapsulated organisms
38
What is cytopenia?
Reduction in the number of blood cells
39
What is leukopenia? What is neutropenia? What is thrombocytopenia? What is pancytopenia?
Low WBC count Low neutrophil count Low platelet count Low RBCs, WBCs, platelets
40
When there is an increase in the number of certain blood cells what ending do the terms take?
...cytosis ...philia
41
``` What is erythrocytosis? What is leucocytosis? What is neutrophilia? What is lymphocytosis? What is thrombocytosis? ```
``` High red cell count High white blood cell count High neutrophil count High lymphocyte count High platelet count ```
42
What is the first responder phagocyte of the innate immune system?
Neutrophils
43
How do neutrophils move towards the site of injury?
By chemotaxis
44
Describe the appearance of neutrophils under the microscope?
Various shapes, nucleus in 3-5 segments
45
Once mature, neutrophils circulate in the blood, invade tissue and live for...
1-4 days
46
What controls neutrophil maturation?
Hormone G-CSF
47
Which hormone controls neutrophil maturation?
G-CSF
48
Name 4 functions of G-CSF with regards to neutrophils
Enhances chemotaxis Increased production of neutrophils Quicker release of mature cells from marrow Enhanced phagocytosis
49
When might recombinant G-CSF be given to a patient?
In the case of severe neutropenia (e.g. After chemotherapy)
50
In the case of severe neutropenia, recombinant G-CSF can be given to patients. Give a possible cause of severe neutropenia?
Post-chemotherapy
51
What is the most common cause of neutrophilia? Give two other causes
Infection Smoking Cancer Steroids
52
What is the typical value for neutropenia? What is the typical value for severe neutropenia?
Below 1.5x10^9/L Below 0.5x10^9/L
53
Neutropenia can be as the result of reduced production or increased removal/use. Give some examples of factors that reduce the production of neutrophils
``` B12/folate deficiency Infiltration of marrow by malignancy/fibrosis Aplastic anaemia Radiation Drugs - chemotherapy/antibiotics Viral infection ```
54
Aplastic anaemia is effectively...
Empty bone marrow
55
Neutropenia can result from either reduced reduction or increased use/removal of neutrophils. Give some examples of factors that can cause the increased removal/use of neutrophils
Immune destruction Sepsis Splenic pooling
56
Give three potential consequences of neutropenia
Severe life threatening bacterial infection Severe life threatening fungal infection Mucosal ulceration
57
Neutropenia sepsis is a medical emergency requiring...
Immediate IV antibiotics
58
Monocytes act as a response to...
Inflammation and antigenic stimuli
59
When do monocytes become macrophages?
Once they migrate to tissues
60
List 4 potential causes of monocytosis
Chronic inflammatory conditions Carcinoma Chronic infections Myeloproliferative disorders
61
Describe the lifespan of an eosinophil
Short lifespan (few days), spend only a few hours in circulation
62
Name three functions of eosinophils
Deal with some parasites Mediator of allergic response Mediate hypersensitivity reactions
63
Eosinophils from the blood migrate to...
Epithelial surface
64
What do the granules in eosinophils contain?
Arginine Phospholipid Enzymes
65
Are eosinophils phagocytes?
Yes - they can phagocytosis antigen-antibody complexes
66
List 6 conditions that can result in eosinophilia
``` Allergic diseases Drug hypersensitivity Parasitic infection Skin diseases Hodgkin lymphoma Myeloproliferative disorders ```
67
Describe the appearance of an eosinophil under the microscope
Dark pink cytoplasm with a bilobe nucleus | Sunburned face with glasses
68
What is the largest WBC and least common type of granulocyte?
Basophils
69
How do basophils appear under a microscope?
With large secretory granules that obscure the nucleus - usually have a bilobe nucleus
70
What are basophils important in? (2)
Allergic reactions | Inflammatory conditions
71
What do the granules in basophils contain?
Histamine Heparin Hyaluronic acid Serotonin
72
Name 4 conditions that can cause basophilia
Immediate hypersensitivity reactions Ulcerative colitis Rheumatoid arthritis Myeloproliferative disorders
73
What are myeloproliferative disorders?
Group of conditions that cause blood cells (RBCs + WBCs + Platelets) to grow abnormally in the bone marrow
74
Where do lymphocytes originate?
In the bone marrow
75
What are three types of lymphocytes?
B cells T cells Natural killer cells
76
Name two types of T cells
CD4+ helper cells | CD8+ cells
77
Name 6 potential causes of lymphocytosis
``` Viral infections Bacterial infections Stress related Post splenectomy Smoking Lymphoproliferative disorders ```
78
What is pancytopenia?
Where there is a reduction in white cells, red cells and platelets
79
Pancytopenia can result from either reduced production or increased removal. State some possible causes of pancytopenia due to reduced production
``` B12/folate deficiencies Bone marrow infiltration by malignancy Marrow fibrosis Immune aplastic anaemia Radiation Drugs - e.g. Chemotherapy/Antibiotics Viruses Congenital bone marrow failure ```
80
Pancytopenia can result from either reduced production or increased removal. State some possible causes of pancytopenia due to increased removal
Immune destruction Hypersplenism - splenic pooling Haemophagocytosis
81
What is haemophagocytosis? What can it result in?
Phagocytosis of the cells in the bone marrow Pancytopenia
82
What is aplastic anaemia?
Pancytopenia with a HYPOcellular bone marrow WITHOUT abnormal infiltrate and fibrosis Effectively, 'empty' bone marrow
83
What effect can malignancy have on blood cell levels?
It can cause pancytopenia
84
The symptoms of pancytopenia will be a combination of the symptoms of... (3)
Thrombocytopenia Anaemia Neutropenia
85
Describe three symptoms of anaemia
Fatigue Dizziness Chest pain
86
Describe two symptoms of thrombocytopenia
Bruising | Bleeding
87
Describe three symptoms of neutropenia
Infection Ulcers Fevers
88
As well as the symptoms of thrombocytopenia, anaemia and neutropenia. What other symptoms will be seen in pancytopenia?
Treatment of the underlying cause
89
Which cell has the greatest ability of self renewal of all adult tissue?
Haematopoietic stem cell
90
Name three sources of haematopoietic stem cells
Aspiration of bone marrow Collection of G-CSF mobilised stem cells in the peripheral blood Umbilical cord stem cells taken at time of delivery
91
Which antigen is used for matching patients in the case of bone marrow transplants?
HLA antigen on WBCs
92
Siblings are how likely to have the same HLA antigens (full match)?
25%
93
What is haemostasis?
The tendency towards a relatively stable equilibrium between interdependent elements
94
Failure in homeostasis leads to...
Disease
95
Name the 4 main characteristics a control system
Stimulus Receptor Control centre Effector
96
What is the function of a receptor in a control system? Name 4 different types of receptors
Detects stimuli Chemoreceptors Thermoreceptors Proprioceptors Nociceptors
97
What are proprioceptors? What are nociceptors?
Sensory receptors that respond to position and movement Sensory receptors that respond to pain
98
Communication between the receptor and the control centre in a control system is via which pathway?
Afferent pathway
99
The control centre of a control system determines the ______ __________ for a system.
Set point
100
The communication between the control centre and effector of a control system is via which pathway?
Efferent pathway
101
What is the function of the effector in a control system? Give two examples of an effector in a control system
Causes change Sweat glands Muscle
102
Can the set point of a control centre change?
Yes - can vary
103
Does core body temperature rise or fall during sleep?
Falls
104
What is a circadian rhythm?
Any biological process that displays an endogenous oscillation of ~24 hours
105
Where is the 'biological clock' located?
In the hypothalamus, in the suprachiasmatic nucleus
106
Which group of neurones in the hypothalamus is the location of the 'biological clock'?
Suprachiasmatic nucleus
107
What are zeitgebers? Give some examples of zeitgebers
Cues from the environment that keep the body on a 24 hour cycle Light, temperature, social interaction and exercise
108
What causes jet lag?
A mismatch between the environmental cues (Zeitgebers) and body clock
109
Which hormone is involved in the setting of the biological clock?
Melatonin
110
Which gland is melatonin released from?
Pineal gland
111
Name a function of melatonin from the pineal gland
Involved in setting the biological clock
112
When are cortisol levels typically at their highest? When are cortisol levels typically at their lowest?
Early morning ---> 7am Evening and early sleep
113
What is the most common form of feedback in a control system?
Negative feedback
114
Negative feedback is a response in a way... Positive feedback is a response in a way...
To reverse the direction of change To change the variable even more in the direction of change
115
Give two examples of positive feedback in the body
Blood clotting | Ovulation
116
Roughly how much of a 70kg man is water?
42 litres
117
As a % of body mass, how much of the body consists of water in... I) males II) females
50-60% 45-50%
118
Of the 42 litres of water found in the body how much is Intracellular and how much is extracellular fluids?
Intracellular - 2/3 (28 litres) Extracellular - 1/3 (14 litres)
119
How much of the extracellular fluid (~14 litres in a 70kg man) is interstitial fluid and blood plasma?
~11 litres of interstitial fluid ~3 litres of blood plasma
120
How many litres of RBCs are there in a typical 70kg man?
2 litres
121
What is osmolarity?
Number of osmoles per litre of solution
122
What is osmolality?
Number of osmoles per kg of solution
123
What is an osmole?
Amount of substance that dissociates in solution to form one mole of osmotically active particles.
124
A one molar solution contains...
1 mole of substance in 1 litre
125
What is the typical range for blood osmolality?
275 - 295 mOsm/kg
126
Which receptors detect blood osmolality? Where are they located?
Osmoreceptors in the hypothalamus
127
If osmoreceptors in the hypothalamus detect high blood osmolality. What two responses will be made?
Increased thirst | Stimulation of the posterior pituitary gland to secrete more ADH
128
Which gland releases ADH?
Posterior pituitary
129
What effect does more ADH being released from the posterior pituitary have on the kidneys, urine produced and blood osmolality?
Increased reabsorption of water in the collecting ducts of the kidneys Small volume of concentrated urine Reduces blood osmolality
130
If osmoreceptors in the hypothalamus detect a low blood osmolality what response will be made?
Posterior pituitary gland secreting less ADH
131
What effect does less ADH being released from the posterior pituitary gland have on the kidneys, urine production and blood osmolality?
Decreased reabsorption of water in collecting ducts of the kidneys Large volume of dilute urine produced Increased blood osmolality
132
Plasma glucose concentration should typically be ~__ mM
5
133
Which hormone is released after eating of a meal? Where is this hormone released from? What causes this hormone to be released?
Insulin Beta cells in the islets of Langerhans in the pancreas Increase in plasma glucose level
134
Name two effects that insulin has in the fed state
Stimulates glycogenesis in the liver | Stimulates glucose uptake into tissues
135
Glucose uptake into tissues (e.g. As a result of insulin) is via which transporter?
GLUT4
136
Which hormone is released in the fasted state? What causes this hormone to be released? Where is this hormone produced?
Glucagon Low plasma glucose concentration Alpha cells in the islets of Langerhans in the pancreas
137
What effect does glucagon have in the fasted state?
Stimulates glycogenolysis in the liver
138
What is the endocrine system?
Collection of GLANDS located throughout the body
139
What is the name of the chemical signals produced in endocrine glands? How do they work?
Hormones Travel in the bloodstream and have their effect on distant tissues
140
Are hormones produced in tissues other than the endocrine glands?
Yes - other organs/tissues can release hormones
141
Give an example of tissues/organs other than endocrine glands that release hormones (3)
Heart (ANP & BNP) Adipose (Leptin) Liver (IGF1)
142
Name 4 mechanisms of communication via Hormones
Autocrine Paracrine Endocrine Neurocrine
143
How does autocrine communication via hormones work?
Hormone signal acts back on the cell of origin
144
How does paracrine communication via hormones work?
Hormone signal carried to adjacent cells over a short distance via interstitial fluid
145
How does endocrine communication via hormones work?
Hormone signal released into the bloodstream and carried to distant target cells
146
How does neurocrine communication via hormones work?
Hormone originates in neurone and after transport down an axon released into the blood stream and to distant target cells
147
What two features do both neurones and endocrine cells have in common?
Both can be depolarised/can secrete
148
Hormones can be classified into which 4 groups?
Peptide/Polypeptide Glycoproteins Amino Acid Derivatives (Amines) Steroids
149
Are peptide/polypeptide hormones, water soluble or lipid soluble?
Water soluble
150
Give three examples of peptide/polypeptide hormones
Insulin Glucagon Growth hormone
151
Which is the largest group of hormones?
Peptide/polypeptide hormones
152
What are amino acid derivative (amine) hormones synthesised from?
Aromatic amino acids
153
Give two examples of aromatic amino acids
Tyrosine | Tryptophan
154
Give three examples of amino acid derivative/amine hormones State which aromatic amino acid each hormone is derived from
Adrenaline (tyrosine) Noradrenaline (tyrosine) Thyroid hormones (tyrosine) Melatonin (tryptophan)
155
Describe the solubility of amino acid derived (amine) hormones
Adrenal medulla hormones - water soluble Thyroid hormones - lipid soluble
156
Describe the structure of glycoprotein hormones
Large protein molecules with a carbohydrate side chain
157
Give three examples of glycoprotein hormones
Luteinizing hormone Follicle stimulating hormone Thyroid stimulating hormone
158
Describe the solubility of glycoprotein hormones
All water soluble
159
All steroid hormones are derived from...
Cholesterol
160
Name three examples of steroid hormones
Cortisol Aldosterone Testosterone
161
Describe the solubility of steroid hormones
Lipid soluble
162
How do most hormones travel in the blood? Otherwise, how do they travel?
Most travel in the blood bound to proteins Some can travel freely
163
Give examples of hormones that can travel freely in the blood
Peptides/Adrenaline
164
A dynamic equilibrium exists between bound and free forms of hormone in plasma, which form is biologically active?
The free form
165
Give three functions of carrier proteins
Increase solubility of the hormone Increases half-life of the hormone Acts as a readily accessible reserve
166
List three factors determining hormone levels in the blood
Rate of production Rate of delivery Rate of degradation
167
Hormones circulate in the blood at which sorts of concentrations?
Very low concentrations
168
Water soluble hormones bind to receptors on which part of the cell?
Cell surface receptors
169
Name two types of receptors that water soluble hormones might bind to
GPCRs | Tyrosine kinase
170
What type of receptor does adrenaline bind to?
GPCR
171
What type of receptor does insulin bind to?
Tyrosine kinase
172
What typically happens to tyrosine kinase on binding of a hormone to a receptor?
Dimerisation Autophosphorylation of specific tyrosines Recruitment of adapter proteins and signalling complex Activation of protein kinases
173
How does insulin binding to a tyrosine kinase have a different effect than normal binding of hormones to tyrosine kinase receptors?
An insulin, tyrosine kinase receptor is already dimerised
174
Lipid soluble hormones bind to receptors on which parts of a cell?
Intracellular receptors
175
How do lipid soluble hormones pass the plasma membrane to bind to Intracellular receptors?
They diffuse across the plasma membrane
176
Lipid soluble hormones can be described as either type I or type II. How does a type I lipid soluble receptor work?
Binds to a cytoplasmic receptor and the receptor-hormone complex enters the nucleus and binds to DNA
177
Lipid soluble molecules can be described as either type I or type II. How do type II lipid soluble hormones work? Give an example of a type II lipid soluble hormone
Enter the nucleus and bind to a receptor that is already bound to DNA Thyroid hormone
178
Binding of a type II lipid soluble hormone to a receptor pre bound to DNA has what effect?
Relieves repression of gene transcription
179
What is a HRE?
Hormone response element Specific DNA sequence in the promoter region of specific genes that receptors for lipid soluble hormones bind to
180
Obesity results from a chronic imbalance between...
Energy intake and energy expenditure
181
Obesity is described as a BMI above...
30 kg/m^2
182
What is the control centre for appetite? Where is it located?
Satiety centre Hypothalamus (arcuate nucleus)
183
Which specific part of the hypothalamus plays a central role in controlling appetite?
The accurate nucleus
184
Most signals in the arcuate nucleus are processed by which neurones?
Primary neurones
185
What are the two types of primary neurones in the arcuate nucleus?
Stimulatory neurones | Inhibitory neurones
186
What do stimulatory neurones in the arcuate nucleus contain that's involved in the control of appetite?
``` Neuropeptide Y (NPY) Agouti-related peptide (AgRP) ```
187
What effect do neuropeptide Y and agouti-related peptide have in the control of appetite?
Promote hunger
188
What do inhibitory neurones in the accurate nucleus contain that's involved in the control of appetite?
POMC which yields a-MSH and B-endorphin
189
POMC in the inhibitory neurone of the accurate nucleus can yield neurotransmitters including a-MSH and B-endorphin. What do these neurotransmitters promote?
Satiety (fed-feeling)
190
How do primary neurones work with secondary neurones in the control of appetite?
Primary neurones synapse with secondary neurones in other parts of the hypothalamus and the signals integrated to alter feeding behaviour
191
Name two hormones that carry signals from the gut to the hypothalamus
Ghrelin PYY
192
Which type of hormone in Ghrelin? Where is it released?
Peptide hormone From the stomach wall when empty
193
What effect does ghrelin have on the hypothalamus?
Stimulates the excitatory primary neurones in the arcuate nucleus stimulating appetite
194
What effect does filling of the stomach wall have on ghrelin release?
Inhibits ghrelin release
195
What type of hormone is PYY? Where is it produced?
Short peptide hormone Cells in the ileum and colon
196
PYY is released from cells of the ileum/colon in response to...
Feeding
197
What effect does PYY have on the hypothalamus and the control of appetite?
Inhibits excitatory primary neurones Stimulates inhibitory primary neurones Suppresses appetite
198
In what circumstances/people might there be a blunted PYY response?
Following food intake in obese humans
199
Describe three hormones that carry signals from the body to the hypothalamus
Leptin Insulin Amylin
200
What type of hormone is leptin? Which cells release it?
Peptide hormone Adipocytes
201
What two effects does leptin have in the arcuate nucleus? What is the overall effect of leptin?
Stimulates inhibitory neurones Inhibits excitatory neurones Suppress appetite
202
In extremely rare cases, individuals may have loss of function of the leptin gene. How is this treated?
Leptin injections
203
Why can leptin injections not be given to patients with common obesity?
Has little effect due to lepton resistance
204
What role does insulin have on the control of appetite?
Suppresses appetite by similar mechanism to Leptin
205
What type of hormone is amylin? Where is it released?
Peptide hormone B cells of the islets of Langerhans in the pancreas
206
What is the overall effect of amylin in the control of appetite?
Suppresses appetite
207
Amylin analogues can be used in the treatment of... Give an example of an amylin analogue
Type 2 diabetes Pramlintide
208
a-MSH from POMC released from primary inhibitory neurones in the arcuate nucleus acts on which receptors at the synapse with secondary neurones?
MC4 receptors

MEH (9 decks)

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